tbuckley/cabot-search huggingface dataset:
Abstract MP55: Glucose Abnormalities Detected by Continuous Glucose Monitoring in Older Adults With Prediabetes
Authors: Natalie Daya Malek, Michael Fang, Dan Wang, Yein Jeon, Justin B Echouffo Tcheugui, Josef Coresh, Elizabeth Selvin
Journal: Circulation (2023)

Introduction: The 2019 Endocrine Society guidelines recommend screening all older adults with prediabetes with a two-hour oral glucose tolerance test. Continuous glucose monitoring (CGM) is a minimally invasive technology that provides insights into glucose patterns and abnormalities not reflected in hemoglobin A1c (HbA1c). Objective: Characterize the prevalence of hyperglycemia and other abnormal glucose patterns in older adults with prediabetes. Methods: Participants in the Atherosclerosis Risk in Communities (ARIC) Study wore a CGM system at visit 9 (2021-2022). We evaluated CGM parameters according to diabetes status. Results: There were 944 participants (272 with diabetes, 342 with prediabetes, and 330 without diabetes) (mean age 83, 58% female, 25% Black). Compared to normoglycemic persons (HbA1c&lt;5.7%), persons with prediabetes (HbA1c 5.7-&lt;6.5%) had slightly higher mean glucose (103 vs 98 mg/dL, p&lt;0.001), a higher percentage of people with mean glucose&gt;140 mg/dL (1.5% vs 0%, p=0.03), spent more time with any hyperglycemia (median % time glucose &gt;180 mg/dL: 0.23% vs 0.04%, p&lt;0.001), spent similar time in range (86.6% vs 86.9%, p=0.68), and had similar glucose variability (CV 21.0% vs 20.8%, p=0.59) ( Table ). The mean amplitude of glycemic excursions, continuous overall net glycemic action and mean of daily differences were also higher in persons with prediabetes compared to normoglycemic persons but the differences are not clinically significant. Mean glucose and other CGM measures of hyperglycemia were substantially higher in persons with diabetes. Conclusion: CGM did not reveal a high prevalence of glucose abnormalities among older adults with prediabetes defined by HbA1c. Our findings do not support the current Endocrine Society guideline recommendations for additional post-load glucose testing in older adults with prediabetes.
Abstract P427: Nutritional Education Strategies’ Impact on Diet in Patients Undergoing Cardiac Rehabilitation
Authors: Katy S Lehenbauer, Ella Scott, Jeremy R Vant Hof
Journal: Circulation (2023)

Background: Nutrition guidelines to reduce cardiovascular disease risk are well-established, and yet few patients regularly eat a healthy diet. Cardiac rehabilitation (CR) is a prime opportunity to provide education and improve nutrition. However, the most effective strategies in nutrition education are not yet established, and outcome data for various nutrition strategies is limited. Aim: This study aimed to evaluate self-reported nutrition metrics for individuals in CR who completed a dietician consultation compared to the usual nutrition class. Methods: Beginning in 2021, CR patients were offered the choice of a 1:1 dietician consultation (“consultation”) or the usual group nutrition class. This study included patients who completed intake and discharge surveys evaluating self-reported healthy food consumption [Rate Your Plate (RYP), 27-81)], confidence in preparing heart healthy meals (0-10), and percentage of heart healthy meals (0-100%). Data were evaluated based on nutrition education strategy and stratified by median baseline score. Results: Of the 166 participants with complete data through August 2, 2022, 87 received a consultation (mean age 65years, 63 males); and 79 chose usual care (mean 63years, 64 males).Final RYP, confidence, and percent healthy meals scores improved in both groups compared to baseline. In general, patients with a lower baseline score had a larger improvement in all nutrition metics regardless of nutrition education group (Table). The average change in RYP score was higher in the consultation arm (+11.7% (59.4 from 53.1); 95% CI [8.3%, 15.1%]), versus usual care (+4.4%, (57.3 from 54.9); 95% CI [2.2%, 6.6%]) . There was no significant difference in change in the other scores between the consultation and usual care group. Conclusion: Individual dietician consultation may be beneficial in providing education and improving nutrition habits for CR patients, especially for those with a low baseline level of knowledge of heart healthy nutrition.
Abstract P583: Cardiac Sarcoidosis is an Under-Recognized Cause of Heart Failure Admissions in the United States: A Population Based Epidemiologic Study
Authors: Yaser Khalid, Kirti Dasu, Neethi Dasu, Bhavana Kadiyala
Journal: Circulation (2023)

Background: Progressive heart failure is the cause of mortality for almost 25% of patients with cardiac sarcoidosis (CA). However, there are limited studies on the impact of heart failure (HF) on mortality, hospital length of stay (LOS), and total hospital charges for patients with cardiac sarcoidosis. Methods: Data were extracted from the National Inpatient Sample (NIS) 2016-2019 Database. The NIS was searched for hospitalizations for adult patients with cardiac sarcoidosis as the principal discharge diagnosis with and without different types of heart failure as secondary diagnosis using ICD-10 codes. Multivariate analysis via STATA was used to adjust for confounders. Results: 6,560 patients were identified with a diagnosis of cardiac sarcoidosis. Only 0.08% of patients with heart failure were identified with a diagnosis of cardiac sarcoidosis, of which 15.8% had systolic HF, 3.7% diastolic had HF, and 14% had combined systolic and diastolic HF. There were more males than females (60.0% vs. 40.0 %, p&lt;0.01). Mortality was increased for combined systolic and diastolic HF (OR 1.98, p&lt;0.04). LOS was increased for patients with any type of HF(+2.48 days, &lt;0.001), systolic heart failure (+2.14 days, p&lt;0.017), combined systolic and diastolic HF (+1.96 days, p&lt;0.010). Total hospital charges were increased with any type of HF ($44,214.43, p&lt;0.004), and systolic heart failure ($58,298.90, p&lt;0.015). Interestingly, patients with cardiac sarcoidosis did not have increased mortality with all types of HF(OR 1.04, p=0.928), systolic HF (OR 0.98, p=0.973), diastolic HF (OR 0.35, p=0.179), and combined systolic and diastolic HF (OR 1.34 experienced a 51% increased odds of mortality (OR 1.51, 95%CI 1.41-1.62, p&lt;0.01), a longer LOS with a mean difference of 1.4 days (95%CI, 1.16-1.57, p&lt;0.01), and a more costly overall hospitalization with a mean difference of $12,841 (95%CI $9,705-$15,976, p&lt;0.01). Conclusion: Cardiac sarcoidosis remains a widely under-recognized cause of HF hospitalizations in the United States.
Abstract MP24: Atherogenic Gut Microbial Metabolite Scores and Risk of Coronary Heart Disease Among Women in the Nurses’ Health Study
Authors: Yoriko Heianza, Xuan Wang, Saumya Tiwari, Qi Sun, Kathryn M Rexrode, Jeramie Watrous, Mohit Jain, Joann E Manson, Lu Qi
Journal: Circulation (2023)

Introduction: Recent evidence suggests that dietary proteins modulate the microbial composition and metabolite production to influence host physiology. Gut-microbiota-related metabolites, such as trimethylamine N-oxide (TMAO) and its precursors, phenylacetylglutamine (PAGln) and p-tolyl (cresol) sulfate, have been recently implicated as atherogenic metabolites derived from the microbial metabolism of protein foods (such as red meat) and amino acids. Hypothesis: We tested a hypothesis that combined effects of atherogenic gut microbiota-related metabolites may be strongly related to the risk of incident coronary heart disease (CHD) among women. Methods: We conducted a prospective nested case-control study of 762 incident cases of CHD (fatal CHD and nonfatal myocardial infarction) and 762 matched controls identified over 10-14 years of follow-up. Plasma metabolites (TMAO, N,N,N-trimethyllysine, PAGln, and p-tolyl (cresol) sulfate) were measured at baseline. We regressed the CHD outcome against metabolites using conditional logistic regression and then calculated an atherogenic microbial metabolite score (AMMS) of CHD by summing the β effects of metabolites. Results: Every 1 SD increment of AMMS was associated with a matching factor-adjusted RR of 1.28 (95% CI: 1.15, 1.44) and a multivariable-adjusted RR of 1.26 (1.12, 1.42) for CHD controlling for demographic, dietary, and lifestyle factors, postmenopausal hormone use, and body mass index. Dose-response analysis showed a linear relation between AMMS and the risk of CHD ( P &lt;0.001). In addition, there was a 1.20 (1.06, 1.36) times increased risk of CHD per 1 SD of AMMS after adjusting for common metabolic comorbidities (diabetes, hypertension, and dyslipidemia). The highest quintile (Q5) group had an adjusted RR of 1.60 (1.08, 2.37) for CHD, as compared to the lowest quintile (Q1) ( Fig ). Conclusions: Atherogenic gut microbiota-related metabolite scores were significantly associated with risk of incident CHD among women without prior CHD.
Abstract 07: Cardiovascular Health and Environmental Justice Concerns of Exposure to Fine Particulate Matter: Insights From the Houston Methodist Outpatient Learning Health System Registry
Authors: Nwabunie Nwana, Omar M Makram, Zulqarnain Javed, Tarang Parekh, Sadeer Al-Kindi, Charlie Nicolas, Rakesh Gullapelli, Stephen Jones, Khurram Nasir
Journal: Circulation (2023)

Air pollution remains a public health concern affecting cardiovascular outcomes. In particular, fine particulate matter measuring ≤ 2.5 μm (PM 2.5 ) is associated with cardiovascular disease (CVD). Of important concern is the potential for this impact to fall disproportionately on communities of low-income and color. We assessed whether living in neighborhoods with environmental justice concerns of exposure to PM 2.5 (EJPM 2.5 ) is associated with CV risk factor burden and CV health (CVH). Our cross-sectional study used data from approximately 1.07 million patients aged 18+ years in the Houston Methodist Outpatient Disease Learning Health System Registry (2016-2021). Linking to the US Environmental Protection Agency (EPA)-Environmental Justice Screen (EJScreen) Database, each patient was assigned an EJPM 2.5 index, and then categorized into 1 of 5 quintiles according to their geocoded residential census block group. Individuals with missing data (n=27221) were excluded. Logistic regression models were used to examine the association between EJPM 2.5 and CV risk factors and CVH. Poor CVH was defined as study participants with ≥ 3 CV risk factors.We included 1044382 patients (mean age 52.31, female 59%, NHB 14%, and 15% Hispanics). Overall, 18% (n=240286) had poor CV health. In our cohort, 27% (n=287077) of patients were exposed to worst PM 2.5 levels (5 th quintile). Overall, those with worst environmental justice concerns to PM 2.5 (EJPM 2.5 ) were associated with higher odds of HTN, DM, obesity and poor CVH. These associations were attenuated, but remain statistically significant accounting for clinical risk factors, demographics and socioeconomic factors. Table . Our findings demonstrate association between EJPM 2.5 and CVD risk factors/CVH. These robust findings support the need to prioritize environmental policies for reducing ambient pollution in communities of color and low-income as this may mitigate the CVD-associated health disparities in these communities
Abstract P447: Association Between Cardiovascular Health (CVH) Throughout Early Adulthood With Prevalent Non-Alcoholic Fatty Liver Disease (NAFLD) in Mid-Life: The Coronary Artery Risk Development in Young Adults (CARDIA) Study
Authors: Seong Park, Hongyan Ning, Lisa B VanWagner, Mercedes R Carnethon
Journal: Circulation (2023)

Background: Nonalcoholic fatty liver disease (NAFLD) is associated with high prevalence of cardiovascular disease and its risk factors. More favorable cardiovascular health (CVH) profiles are associated with a lower prevalence of NAFLD in cross-sectional studies. However, the relationship between long-term CVH patterns in early adulthood and prevalence of NAFLD in midlife remains unknown. We aimed to assess these patterns. Methods: We used data from participants (18-30 years at baseline) of the CARDIA study who had individual CVH components measured at 7 examinations over 20 years and liver fat assessed by non-contrast computed tomography (CT) at year 25 follow up. Group-based trajectory modeling was used to create CVH trajectories, according to American Heart Association definitions, from baseline through follow-up year 20. NAFLD was defined as liver attenuation of &lt; 51 HU after exclusions. Dichotomous logistic regression was used to examine associations of baseline CVH scores (n=2618) or CVH trajectory group (n=2529) and prevalence of NAFLD at year 25. Results: At baseline, 39% of 2618 participants had high and 5% had low CVH, respectively. At year 25, NAFLD prevalence was 23% (n = 609). At year 25, compared to those without NAFLD, participants with NAFLD were more likely be male (54.2% vs. 37.3%) and be a current smoker (27.1% vs. 21.7%) at baseline. Participants with low (HR = 3.24, 95% CI = 2.13, 4.95) and moderate (HR = 1.85, 95% CI = 1.50, 2.29) CVH scores at baseline were more likely to have a higher risk of prevalent NAFLD compared to participants with high CVH scores. Five distinct trajectories of CVH were identified. Lower and decreasing trajectories were associated with higher risk of prevalent NAFLD at year 25 compared to the high stable trajectory (Figure). Conclusion: Low CVH scores in young adulthood and low and decreasing CVH trajectories throughout early adulthood are associated with higher prevalence of NAFLD in midlife. Optimizing CVH in early adulthood is critical for lowering risk for prevalent NAFLD in midlife.
Abstract P361: Cardiovascular Health in South Asian American Adults in the MASALA Study: Updated Metrics Using the Life’s Essential 8 Definitions
Authors: Nilay S Shah, Bridget M Hussain, Sameera Talegawkar, Yichen Jin, Namratha Kandula, Alka M Kanaya
Journal: Circulation (2023)

Introduction: The AHA Life’s Simple 7 (LS7) score was recently updated to the Life’s Essential 8 (LE8) score which revised cardiovascular health (CVH) scoring, including accounting for Asian-specific body mass index, secondhand smoke exposure, and sleep. We evaluated CVH in South Asian American participants of the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study. Methods: At the MASALA baseline exam, median LE8 CVH score was calculated across levels of the LS7 score. Age- and sex-adjusted mean LE8 CVH score was compared by income, education, and country of birth using linear regression. Logistic regression evaluated the age- and sex-adjusted association of LE8 CVH with prevalent coronary artery calcium (CAC) score greater than 0. Sleep duration was not available, so the LE8 score was calculated with the 7 original CVH factors. Results: Among 1,093 South Asian American adults in the MASALA Study (48.5% female, mean age 56.7 [SD 9.4] years), mean LE8 CVH score was 68.7 (SD 11.6). The LE8 and LS7 CVH scores were significantly correlated (r=0.78, p&lt;0.01). Median (interquartile range) LE8 score across levels of LS7 score is shown in the Figure. Mean adjusted LE8 score was significantly higher (p&lt;0.01) among those with annual income ≥$75,000 vs. &lt;$75,000 (70.0 [11.6] vs. 65.7 [10.9]) and those with more vs. less than college education (69.5 [11.3] vs. 67.7 [11.8]). Mean LE8 scores significantly varied by place of birth (Bangladesh 69.3 [14.8]; India 69.2 [11.3]; Pakistan 61.0 [11.7]; Sri Lanka 63.9 [11.7]; United States 68.2 [13.7]; p&lt;0.01). A 10-point higher LE8 score was associated with lower odds of prevalent CAC (OR 0.67 [95% CI 0.58-0.76]). Odds of any CAC was higher for participants with low (score 0-49) or moderate (score 50-80) vs. high (score 80-100) CVH (low: OR 5.43 [2.51-11.77]; moderate: OR 3.23 [2.07-5.06]). Conclusions: The LE8 CVH score is highly correlated with the LS7 CVH score among South Asian American adults, varies across sociodemographic factors, and is associated with odds of prevalent CAC.
Abstract P346: Adherence to the French Dietary Guidelines and Type 2 Diabetes Risk: The E3n-Epic Prospective Cohort Study
Authors: Daouda Seck, Sanam Shah, Bamba Gaye, Nasser LAOUALI
Journal: Circulation (2023)

Background: Recently, a dietary index reflecting adherence to the 2017 French food-based dietary guidelines, the Programme National Nutrition Santé - guidelines score 2 (PNNS-GS2), has been developed, but evidence on its level of adherence and incident type 2 diabetes (T2D) risk is limited. Objective: We aimed to investigate the association between adherence to the simplified PNNS-GS2 (sPNNS-GS2) and the risk of incident T2D in a French cohort of women. Methods: Between 1993 and 2014, 71,450 women aged over 18 years were examined, and thereafter followed up for the occurrence of T2D within the E3N-EPIC prospective cohort. Dietary data were collected at baseline via a food frequency questionnaire, and the sPNNS-GS2 was derived for each participant. Multivariable Cox regression models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) of T2D for continuous and quintile groups of the sPNNS-GS2. Effect modification by body mass index (BMI) and mediation by BMI and waist-hip ratio (WHR) were explored. Results: The mean age was 52.9 years (SD 6.7). During a mean follow-up of 19 years, 3679 incident T2D cases were identified and validated. There was a linear association between adherence to sPNNS-GS2 and T2D risk (P non-linear = 0.85). In the fully adjusted model, each 1-SD increase in the sPNNS-GS2 was associated with a 8% decrease risk of T2D [HR (95% CI), 0.92 (0.89, 0.95)]. Compared to those with the lowest adherence (first quintile), the third [HR (95% CI), 0.91 (0.82, 1.00)] up to the fifth quintile group [HR (95% CI), 0.79 (0.71, 0.88)] had a lower T2D risk. There was a sPNNS-GS2 x BMI interaction on T2D risk (P interaction &lt; 0.01) but not with WHR. The overall association was partly mediated by BMI (18%) and WHR (59%). Conclusion: Higher adherence to the 2017 French food-based dietary guidelines was associated with a lower risk of T2D in women. Furthermore, our mediation analysis suggests that the lower risk of T2D in women associated with adherence to the sPNNS-GS2 is partly mediated by obesity measured by BMI or WHR.
Abstract P201: Plasma Proteomic Signatures of Angptl3/8 and 4/8 Before and After Exercise Training
Authors: Sebastian Miranda-Maravi, William G Hoffman, Prasun K Dev, Jacob L Barber, Charles S Schwartz, William A Clarkson, Jeremy M Robbins, Prashant Rao, Michael Mi, Sujoy Ghosh, Clary Clish, Gunther Silbernagel, Yan Q Chen, Robert J Konrad, Claude Bouchard, Robert E Gerszten, Mark A Sarzynski
Journal: Circulation (2023)

Introduction: Angiopoietin like protein (ANGPTL) complexes 3/8 and 4/8 are established inhibitors of lipoprotein lipase and modifiable by regular exercise. However, the molecular biomarkers related to their exercise responses have not been fully elucidated. The purpose of this study was to examine the associations between plasma proteins and ANGPTL3/8 and 4/8 before and after exercise training. Methods: Measurements were taken before and after 20 weeks of exercise training in 630 adults (36% Black, 56% women, mean age 35 yrs) of the HERITAGE Family Study. Meso Scale Discovery immunoassays were used to measure ANGPTL3/8 and ANGPTL4/8 complexes in serum. Plasma proteins (n=4979 aptamers) were quantified using SomaScan. Linear mixed models tested the association between plasma proteins and each trait at baseline and post- training with full covariate adjustment. Significance was set to FDR&lt;0.05. Results: A total of 862 and 126 proteins were significantly associated with ANGPTL3/8 at baseline or post-training, respectively, with 80 proteins associated at both time points, including PCSK9 and PLTP ( Figure 1A ). Conversely, 46 proteins were only associated with ANGPTL3/8 at post-training, 23 of which whose levels significantly changed with training including NRP1, ghrelin, HHIP, and APOA1. A total of 433 and 71 proteins were significantly associated with ANGPTL4/8 at baseline or post-training, respectively, with 46 proteins associated with both time points ( Figure 1B ). A total of 25 proteins were only associated with ANGPTL4/8 at post-training, 12 of which whose levels significantly changed with training including ghrelin, COL6A2, and MMP16. Conclusions: We identified a subset of proteins uniquely associated with exercise-induced changes in ANGPTL3/8 and 4/8. Thus, the responsiveness of ANGPTL3/8 and 4/8 to regular exercise may be related to cholesterol esterification, lipoprotein remodeling, inflammatory response, and regulation of fibrinolysis and coagulation among other biological pathways.
Abstract P333: Asian-Specific BMI Cutoffs as a Predictor for Mortality Risk
Authors: Nhan Nguyen, Amin Sajjadian, Gaël Cruanes, Adrian Bacong, Armaan Jamal, Malathi Srinivasan, Robert J Huang, Gloria S Kim, Latha Palaniappan, Karina Kim, Eugene Yang, Tali Elfassy
Journal: Circulation (2023)

Introduction: Prior studies have found a U-shaped association between body mass index (BMI) and mortality. The WHO has recommended Asian-specific BMI guidelines to better screen for BMI-related diseases among Asians. Little is known about patterns between BMI and mortality rates in Asian subgroups. We used Asian-specific BMI cutpoints to determine whether BMI was associated with mortality among disaggregated Asian subgroups. Methods: A sample of Asians (n=26,831) was obtained from the 1999-2018 National Health Interview Survey (NHIS) linked to the National Death Index. BMI was calculated with self-reported height and weight. Individuals were grouped into 4 BMI classes by Asian-specific BMI cutpoints: underweight (BMI &lt;18.5), normal (BMI &gt;18.5-22.9), overweight (BMI &gt; 23-24.9), and obese (BMI ≥ 25) categories. Using Poisson models, we calculated the age-standardized mortality rate (ASMR) per 1,000 person years (PY) for All Asian adults and specific sub-groups (Asian Indian, Chinese, Filipino, Other Asian) with normal weight as a reference. Results: Our sample was comprised of 20.6% Chinese (n=5517), 22.8% Filipino (n=6111), 19.5% Asian Indian (n=5232), and 37.2% Other Asian (n=9971). Compared to normal BMI, underweight individuals had significantly higher ASMR among all Asians and more specifically among Chinese, Filipinos, and Asian Indians, but not among Other Asians. Compared to normal BMI, risk of mortality was not significantly different among overweight or obese individuals across any Asian subgroup. Conclusion: We found that low BMI was consistently associated with increased mortality among all Asian subgroups. In contrast to what has been described in Non-Hispanic White adults, we found that overweight or obesity was not associated with increased mortality among Asian American subgroups utilizing Asian-specific cutpoints.